Just Because You Ask, Doesn't Mean You Get

Many pregnant women in the US who request postpartum sterilization ultimately do not undergo the procedure (46%). Consequently, health care providers should counsel all women who desire postpartum sterilization about a wide array of contraceptive methods, according to a report in the April issue of Obstetrics & Gynecology.

Researchers at the University of Illinois at Chicago studied 712 women who expressed a desire for postpartum sterilization during their prenatal care. Sterilization is the most commonly used method of contraception for women in the US. Sterilization performed during the postpartum hospital stay offers many advantages, including lower failure rates than other methods of sterilization. Yet the issue of whether and why women do not obtain a postpartum sterilization procedure they have requested has been poorly studied in the US.

Study authors noted that both personal factors and factors related to the health care system (such as delays in operating room or staff availability) may have an impact on why women do not obtain this requested procedure postpartum. The study found that being young (21 to 25 years old), being African-American, making the request during the second trimester of pregnancy, and having a vaginal delivery instead of a cesarean delivery were factors significantly associated with not undergoing sterilization.

While some women change their minds about being sterilized, there is the possibility that their initial sterilization request reflected a concern about whether they could successfully use reversible contraception to prevent unintended pregnancy, note the study authors. Thus, some women who request sterilization may need more rather than less counseling about reversible contraception. The researchers are currently conducting a longitudinal study to further investigate factors affecting women's decisions on sterilization and contraception.